Can mandatory pretransfusion approval programmes be improved?

Abstract

To improve the appropriateness of blood-component prescribing, a mandatory haematologist pretransfusion approval programme of all non-red-cell components was instituted. This was associated with a 33% decrease in the units of fresh frozen plama (FFP) transfused. Platelet transfusions increased but utilization of both platelets and FFP are now the lowest of the six comparable blood transfusion regions in New Zealand. A subsequent concurrent audit, using preset criteria, of FFP, cryoprecipitate and platelet usage over a 3-month period showed that further reductions in blood component usage could still be achieved, despite the continuing pretransfusion approval policy. This audit showed that 33% of FFP and 30% of cryoprecipitate units transfused were inappropriately given, despite prior haematologist approval. Hospital transfusion practices can be improved by mandatory blood-component pretransfusion approval but concurrent auditing of this programme is required to identify and correct continuing inappropriate blood-component prescribing. Haematologists need to agree on blood-component indications prior to instituting a pretransfusion approval programme in order to provide optimal management.

Utilization of blood and components in a tertiary care hospital

“…This is important to prevent misuse which may lead to shortage of blood availability and thus denial of blood supply to someone in a life-threatening situation. The importance of an internal audit and education programs, emphasizing proper selection of blood components for patients and avoiding their overuse, has been highlighted by various authors who reported a marked decline in inappropriate demands for blood products after such audits were followed by educational sessions for clinicians [2][3][4][5][6][7].…”

“…Presently, with advent of blood component usage for specifi c needs of patients, better guidelines have been suggested and put to practice globally. In many hospitals, it is now a standard practice of blood bank to manufacture different blood components from donated whole blood units and supply only components thereafter to patients [3,4,6,8].…”

“…Yeh et al carried out audit on FFP usage and followed it by fi ve sessions of education on transfusion guidelines which resulted in 30% decrease in inappropriate FFP usage [2]. Hawkins TE instituted a system of pre-transfusion approval which resulted in 33% decrease in units of FFP transfused [3].…”

Audit and Education in Transfusion Medicine

“…The guidelines were mod ified together with ordering physicians after an audit had been performed. Hawkins et al [24] in New Zealand also found that a mandatory pretransfusion approval program decreased the use of FFP by 33%.…”

Resident Doctors Education on Appropriate Utility of Blood Components

“…It is now a standard practice of all blood banks to manufacture different blood components from donated whole blood units and supply only components thereafter to patients. [13,14,15,16] However use of whole blood is recommended in certain situations, instead of replenishment of blood loss through components.…”